Tuesday, January 31, 2017

I strongly recommend this piece from The Body (a website for people living with HIV and those who care about them), by policy advocate Michael Kink, which most strongly articulates the direct effect of Medicaid block grants on people living with HIV, and others whose health needs are unpopular.

The most important thing he highlights is that state control of Medicaid programs ultimately means there is no longer a right to care once you get into the specifics. What Medicaid will pay for will be the states' responsibility--or lack of responsibility. In the long run, if a state wants to restrict or even eliminate necessary treatment, it may. This is another dark side to block grants, beyond the simple funding cuts. That is, saying "the states know best" not only is a cover for cutting budgets, but a cover for justifying bad care.

This is a crucial argument that needs to be highlighted more clearly, to emphasize that although Medicaid block grants are most broadly a way of enacting cruel budget cuts, they have the potential to more specifically accomplish other terrible and pernicious policy aims as well.

* * *

Sufjan Stevens' "Casimir Pulaski Day" is a stunning song, more and more stunning the more I listen to it, and I've been listening to it for a few years now. It's about a kid whose friend-kinda-girlfriend dies of "cancer of the bone"; and the way that event makes life and the universe more sad and complicated for everyone around her.

And maybe we just leave it at that.

Or maybe we return to point out that for people with rare diseases, block grants have the potential to...

...Or not. Maybe sometimes it's best to just let the song be the song.

Thursday, January 26, 2017

state of the state

Don't get me wrong, I loved Jerry Brown's State of the State speech. But it's just not true that California has had "a spirit of adventure and openness that has welcomed - since the Gold Rush of 1848 - one wave of immigration after another." It's true that California has had many waves of immigration--but it's also been home to multiple anti-immigrant movements, including brutal attacks on Chinese immigrants in the nineteenth century, embracing internment camps for Japanese-Americans in the mid-twentieth, and the anti-immigrant policies of California's Republican Party in the early 1990s.

If there's one thing that frustrates me in leftist rhetoric as much as right-wing rhetoric, it's the frequent historical revisionism about what America is and has been. We've always been at war with each other about what America is supposed to become. There has never been one unified vision of the United States. It stuns me when people pull out these "We have always been [insert noble sentiment here]" statements.

And that said, even in times of the unkindest politics, there have always been dissenters; always people who called on their fellow Americans to rise to more love and less hate; always people who believed in a pluralistic and small "d" democratic America where all were welcomed. It's too simple to say, for instance, that white supremacy has been the sole definition of American society; if it has been a prominent and constant political theme, it has also always been met with opposition and resistance.

To say "America has always been" or "California has always been" is almost always the lead-in to an intellectually lazy assertion that one's own ideal of America is the truest or longest-dominant strain of American politics or thinking. If the current situation reminds us of anything, it's that there is never one America, and has never been one America, and probably never will be. However, it is possible for a kinder version of America to prevail over its opponents. And that should be our goal; not the restoration of some golden age of unity which never existed.

Wednesday, January 25, 2017

Medicaid round up, with Fast Car (disco/guilty pleasure) and Fast Car (legit)

from a 2011 protest... in another Medicaid battle...

Yes, it is happening. They are spewing the exact rhetoric you would predict about Medicaid block grants (see prior posts), and though governors are pushing back... I mean, governors? Sad. Losers.

Families USA has this factsheet regarding Medicaid block grants (h/t Doctors for America).

Kevin Drum at Mother Jones has a good explainer with graphics showing why pegging block grant increases to overall inflation is inevitably budget cutting.

In a related development, Medicaid block grants in Republican-dominated states will likely lead to privatization, which in Iowa has been a bad deal for providers of care, as explained in this STAT article.

And yes, Republican governors, not surprisingly, are continuing to sound the alarm, that umm, guys, that's a bunch of money you're about to take away from my state. Sadly, Governor Kasich may not wield awesome political influence in today's GOP. Because: Loser. Sad.

Investors get a warning that it's time to be bearish on any healthcare investments that involve poor people.

And for locals, here's an article on concerns of Massachusetts legislators--and how our rate of 97.2% residents being insured (this can be done! we have done it!) might be at risk, and what the state might do. Basic summary: we're not sure how we're gonna get damaged, and we're not sure how we're gonna fix it, but we're gonna get damaged, and we're gonna try to fix it.

Zooming out of Medicaid proper and into the ACA, here's why the "moderate Republican" alternative isn't viable.

And in the continuing Mu-Receptor Mixtape commitment to bring you health policy beatz, can there ever be too many Swedish-disco-house takes on "Fast Car"? Tobtok (featuring River) apparently feels the answer is no, and made a cyyyyyuuuuuute video to prove it. I have a weakness for this which can not be entirely justified aesthetically. (PS: Yes I know Jonas Blue did a prior Swedish-disco-house-style version. But the song isn't better and the video is literally just... the stupidest. I'm not even linking to it.)

Health policy verse is:

You see my old man's got a problem
He live with the bottle that's the way it is
He says his body's too old for working
His body's too young to look like his
My mama went off and left him
She wanted more from life than he could give
I said somebody's got to take care of him
So I quit school and that's what I did

Again emphasizing that the economic impact of untreated health problems extends far beyond those with the health problems. Right, Tracy Chapman? Holy crap, so many years later I still think this is a beautiful song, and children, this is the woman who actually wrote it, and the reason why even though I love that disco house music, I'm sort of ashamed to even like any of the multitude of remixed and redone versions, because: Tracy Chapman.

Friday, January 13, 2017

Star Wars: not all bad policy comes from bad policymakers

Sunday, January 1, 2017

Oxycontin Blues

Steve Earle introduces it at a live show (also on YouTube): "If you don't know what Oxycontin is, it's just another kind of dope."